Case Written: Sep 1, 2008

"I have been lazy," the home-breeder replied when I told him that he could have 2 strong and vigorous pups if he had gone for elective Caesarean section after 60th day of pregnancy.

He had also waited more than 3 hours to seek a Caesarean section when the water bag appeared. If he had immediately called a veterinarian to do a Caesarean section on seeing the water bag hanging loose from his Poodle, he would have saved that pup. When I did the Caesarean section, the pup whose water bag had hung out from the dam for >3 hours was in great distress. Water bubbled out from her lungs. I swung her and rubbed her. She cried weakly. She was barely alive. She was not vigorous unlike the second pup. So, I doubt she would make it.

Here are the tips for the home-breeder:

1. Have a good relationship with a veterinarian. Obviously if you doctor-hop, you can't develop a veterinarian-client relationship of trust.

2. Get pregnancy diagnosis at the 28th day after the first mating. 

3. Small toy breeds like Yorkshire Terriers do need Caesarean section. Delays lead to distressed pups which cannot suckle and need close nursing and stomach feeding. Many home breeders don't know how to do it and the pup dies after 2 days.

4. Be vigilant if you don't wish to pay for elective Caesarean sections. Sometimes the dam can give birth naturally. You will need to monitor the dam. Once the dam can't give birth after 2 hours, contact your veterinarian and get the Caesarean section done.

5. A change of mindset. After all, the objective of breeding is to produce live pups, not to save money on Caesarean section. Consult your veterinarian regularly. 

Here are the tips for the veterinarian:

1.  Time is of the essence. Do not waste time trying to pull out the puppy since it is likely to be stuck inside.

2. Intubation is ideal. However, in some case such as this case, the dam has been debarked. The normal size 5 endotracheal tube cannot enter the trachea. A size 3 endotracheal tube could. However, much time is wasted as the dog wakes up and struggles. In this case, a face mask giving isoflurane gas is used without problem. The vet assistant does nothing but monitor the anaesthesia - tongue colour, pedal reflexes and breathing rates.

3. Use the minimal maintenance dose of gas. 0.5 - 1% was all right for this toy poodle.  

In conclusion, the home-breeder needs to care for the health of the dam. Elective Caesarean costs money. But many times, they are the best choice for toy breeds with big pups. Viable and vigorous pups are delivered. The dam is much less distressed by prolonged dystocia or die in cases where dystocia drags on for many hours. Her pups are most likely to survive the first 2 weeks and the breeder spends less time nursing distressed or orphaned pups.

An elective or prompt Caesarean would have saved the large pup. As the absorbable 3/0 stitch did not dissolve and drop out on day 21 after the Caesarean section, the owner brought in the fiercely protective dam for examination on Dec 16, 2008.

The puppy was "sucking" the stitches.  I removed the 2 horizontal mattress stitches.
The happy 11-year-old daughter told me that the pup was thriving and growing bigger. It was good news.

In retrospect, an elective Caesarean section done around the 60th - 63rd day would have given the owner 2 live pups. "59-63 days" after mating is one of the range of dates for birth of puppies in the dog. "70 days" will be overdue as you can see the fully developed coat of the pups. 

Disappearing puppies for the non-professional home breeder
I spoke to the owner in May 2009 when the dam came in for a second Caesarean section. This was an elective Caesarean section.  The pup did disappear between the fridge and the washing machine. Fortunately, she was discovered when the owners found her missing and looked everywhere for her.

A nesting box with a wall of around 10 cm would have prevented pups from homing towards a hot source (the refrigerator) instead of the dam's body. Pups can't tell the difference and some have had died due to this lack of barrier.

VETERINARY TIPS:
1.  An X-ray or ultra-sound scan at 60th day would have revealed the large pup which would never be born naturally.  Abdominal palpation would also reveal a larger than normal pup but the vet needs to be a bit more experienced in abdominal palpation.  However X-rays and ultra-sound scans cost money and no owner or professional breeder wants to spend money. 

2.  Each veterinarian has his own preferences in the surgical approach to Caesarean section. I find that the shortest skin and uterine incision sufficient to get the head and body out has less problems of stitch biting and breakdown. It also shortens the anaesthetic time.

Other vets may feel more comfortable making a longer incision, take out the whole womb of the body, incise the uterus, get the pups out. Then they flush the abdomen with saline and put in some antibiotic liquid (or tablets) before closing the abdomen.  A professional dog breeder was  impressed by the flushing of the uterus with saline to remove the blood present after Caesarean.  

3.  My procedure after stitching up the uterus:
I don't do it as I believe that the less outside solutions or medication introduced into the abdomen, the better it is for the dam. Such external solutions can never be sterile and may cause peritonitis. So why take the risk? I press the abdomen to get as much  blood out of the abdomen as possible. I use sterile cotton swabs to remove the blood.  As each veterinarian has his own procedure, it is a matter of professional difference in the approach to surgery and asepsis. 

An elective Caesarean section for the heavily pregnant Chihuahua is necessary as the dam may be unable to contract her womb to expel all 5 pups.  Proper planning with your veterinarian to get the Caesarean section done during office hours will save the home-breeder a lot of money and worry. This was what happened to the owner of the Chihuahua from Case Study 2. 

Dam kills the puppies - Canine post-partum depression?  
This does happen sometimes for reasons not well known. It would be likely due to stress. Or in human medicine - a post-partum depression when the mother felt like killing the baby.

I advised the owner regarding the possibility of the dam killing her 5 pups after the elective Caesarean Section. 5 pups appeared to me to be too much for her and she looked nervous. Something in her eye glare gave me an intuition that this dam would kill her puppies as there were too many.  A surrogate dam would be used to suckle the 4 pups but this was a home-breeder without such a fall-back support.   

The dam was cleaned up. Red blood shot out from her vagina and onto the towel as she was photographed. "There is nothing to worry," I said. "This bleeding is common after Caesarean Section. It will stop within 2 days." 

Then I advised:  "Nobody should be able to get a good night's sleep tonight. There must be a 24-hour vigilance and monitoring of the mother. One person must be there all the time and feed the puppies with some milk from the milk bottle. It is possible that this mother will bite and kill her puppies." 

"She will not do it," the father was confident as the dam had successfully reared the first pup in the first Caesarean section (see pictures in Case 2).

NOTE:
The pregnancy was an accident. The owners felt sorry for the sire who was crated for the 7 days the dam had her heat (vulval bleeding). As the bleeding had stopped around the 7th day, the sire was given freedom. "Only one shot," the father told me. That was sufficient to cause pregnancy. 

The father had wanted the spaying to be done after Caesarean section. I don't advise such a procedure as the dam had to produce milk for her puppies. I don't know whether such an operation would affect milk production or the health of the dam.

In any case, the rectal temperature of the dam was 35.5 degrees C, half an hour after the end of the Caesarean section. The Chihuahua was shivering due to hypothermia. Glucose and dextrose saline IV was given. Calcium, Baytril antibiotic and Oxytocin injections were also given. The dam went home with the puppies to a happy family of two parents and 2 teenaged children. On May 7, 2009, 3 days after the Caesarean section, the 11-year-old daughter phoned me: "The mother bit 2 puppies in the stomach and the head. Blood came out. What can I do?"  Two puppies had died when no family member was monitoring the dam. "Muzzle the dam," I said. "Or keep a 24-hour watch on the dam. Take away the puppy after suckling milk and use tissue paper to wipe the puppy's lower part and backside to stimulate the puppy to pee and poop."

The dam would not attack the remaining 3 puppies as a family member would be around. This seemed to be equivalent to a case of post-partum depression in women. I presumed that the baby would suffer adversely if the human mother was also severely depressed.

Many Singapore owners forget about spaying the dam after the Caesarean section. The best time to spay the female would be at around 7th -10th week after Caesarean section and there would be no more milk in her breast. The puppies should have been weaned to solid food at the 4th to 5th week.

Due to forgetfulness, another pregnancy may occur, even with "one shot". It is like closing the  stable door when the horse has bolted?  Spaying can be done 1 month after the puppies are weaned and there should be no more milk in the dam.

I hope the above-mentioned tips from real-life cases will be useful to many home-breeders of small breeds and veterinary students all over the world.